Spanish experts have proposed a new way of classifying COPD exacerbations that they say may help provide better personalised care to patients.
In a viewpoint in The Lancet, Drs Jose Luis Lopez-Campos and Alvar Agusti said exacerbations were traditionally thought to result from infection, but the causes, consequences and optimal treatments are more complicated.
A worsening of respiratory symptoms – a key to the definition of an exacerbation – can have biological causes, clinical triggers and social influences and might not necessarily be an exacerbation of the underlying disease, they said.
The key was understanding the biology as well as the severity of a patient’s COPD exacerbations, they said.
Exacerbations differ in the extent of the inflammatory response as well as clinical severity, Dr Lopez-Campos explained.
“COPD exacerbations are currently managed by three main treatments: bronchodilators, antibiotics and systemic steroids,” he told the limbic.
“If we assume that bronchodilators are given to every patient with an exacerbation, then the question is when to use antibiotics and/or systemic steroids.”
Currently clinicians use severity signs and sputum purulence to decide which treatment to provide.
“This is too simple a scheme based on subjective items for severity and does not capture the variability in the inflammatory load. A better categorisation of these events is needed,” he said.